This is what I do as well. We actually had a recent case where we had cut the medicare a, the family requested demand bill, and this was sent in with continuing MDS's through the 100 day cycle. Well... Medicare is paying, so thank God, for the assessments we did or else we would be taking default rate!
Brenda W. Chance, RN, RAC-C MDS Coordinator CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. -----Original Message----- From: Faye Jones [mailto:[EMAIL PROTECTED] Sent: Thursday, April 15, 2004 1:33 PM To: [EMAIL PROTECTED] Subject: RE: demand bill..Need help! Just a comment. We always do sufficient PPS assessments to provide for approx 30 days worth of RUGS categories so that in the event the FI overturns our decision we will get paid at the appropriate rate not the default rate. It is not a requirement but being financially responsible. We have not had many of our decisions overturned but why take a loss even once. Think of it this way. IF the difference between default and the correct RUGS is $50 and the FI decides the resident should have been covered for 7 more days there is a possible loss of $350 income. This happened here exactly once and our administrator said "How can we avoid this in the future?" and the rest is history. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Orth, Ron A Sent: Thursday, April 15, 2004 12:15 PM To: '[EMAIL PROTECTED]' Subject: RE: demand bill..Need help! Your missing my point. The facility already made the determination that they did not feel that the resident met skilling coverage so they issued a cut letter. The resident or responsible party requested a demand bill since they obviously did not agree with this decision or wanted the FI to make the determination. Since a demand bill was requested, the facility should continue with the PPS assessments so that if the FI disagrees with the facility and should have kept them skilled (this is where the FI determination comes in) then they would be able to appropr. bill a RUG score instead of default. If the FI agrees with the facility, then the resident/responsible party would be liable for the care rendered from the time of the cut letter forward. Ron -----Original Message----- From: Faith Palermo [mailto:[EMAIL PROTECTED] Sent: Thursday, April 15, 2004 10:33 AM To: [EMAIL PROTECTED] Subject: RE: demand bill..Need help! I disagree it's not up to the FI to decide what your rugs catagory is, what are you going to reskill the resident with??? Rehab??? nursing?? then why was he cut in the first place? >>> [EMAIL PROTECTED] 04/15/04 10:56AM >>> That is up to the FI to decide, that is the whole purpose of a demand bill. If the FI decides that the services provided were skilled, the facility would be liable for that part of the stay and not be able to bill the resident. They could bill medicare, but would be at the default rate since no assessments were done. -----Original Message----- From: Faith Palermo [mailto:[EMAIL PROTECTED] Sent: Thursday, April 15, 2004 8:24 AM To: [EMAIL PROTECTED] Subject: RE: demand bill..Need help! what would the skilled service be????? >>> [EMAIL PROTECTED] 04/15/04 09:10AM >>> Actually I would disagree. I would resume the PPS schedule now to end the default. If it is day 75, then do a 60 day assessment (late). If the FI decides that they should have been skilled this entire time, you would have to bill default for the days without the assessment then bill whatever RUG score you obtain from this late 60 day. ron -----Original Message----- From: Faith Palermo [mailto:[EMAIL PROTECTED] Sent: Thursday, April 15, 2004 8:01 AM To: [EMAIL PROTECTED] Subject: Re: demand bill..Need help! No by putting them back on the pps cycle, that means you should have never cut them in the first place. What would you be skilling them for now? >>> [EMAIL PROTECTED] 04/15/04 08:29AM >>> Thanks for your response...I know I do not have to restart the PPS cycle. But do I have to put the person back on the PPS cycle. Example....We cut the resident on day 14. It is now day 75 of their admission. Do I do PPS assessments for the 25days they have left within the benefit period. Or are you saying I do not have to do anymore PPS assessments. Am I explaining this well?? As it stands now, if someone requests a demand bill we keep them on PPS until we get the decision regarding the demand bill. How should the billing department bill for this person? FI told them they are to bill at the default rate from the cut date to current date. Faith Palermo <[EMAIL PROTECTED]> wrote: No you don't start the pps cycle over again. A demand bill just means the family is not agreeing with your facilities decision to cut the resident. The demand bill along with your facilities documentation of why you cut the resident needs to be sent to your FI then Medicare reviews the information and may ask for ADR ( additional documention request). And they will let you know if you cut the resident too early or if it was appropriate. If they agree with the family they may reduce payment or not pay at all for the time resident was skilled, but you don't need to restart the pps cycle. >>> [EMAIL PROTECTED] 04/15/04 07:46AM >>> Resident was discharged from MedA when therapy was cut and there was no other skilled need. Denial letter was sent to family certified mail return receipt. No response to denial letter. As per our denial letter if you do not respond within 14days days we assume you do not want a demand bill. Now, 2 months later, the family is requesting a demand bill. Do I pick up where she left off?? There is no 30day or 60day assessment and now it would be time for her 90day. Do I start with the current date as the ARD and code it as a 30day or 90day? Thanks for any help! --------------------------------- Do you Yahoo!? Yahoo! Tax Center - File online by April 15th NOTICE: This confidential message/attachment contains information intended for a specific individual(s) purpose. 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